Mood disorders impact the health of children, adolescents, and adults worldwide. The World Health Organization estimates that by the year 2020, depression will remain a leading cause of adult disability, second only to cardiovascular disease (World Health Organization 2000). Evidence also supports the presence of disabling mood disorders during childhood and adolescence. Estimates suggest that as many as 2% of children may be depressed at any period of time (Kaufman et al. 2001; Kessler et al. 2001), and the rate increases during adolescence. Lifetime prevalence rates for adolescent depression derived from community studies range from 5% (Lewinsohn et al. 1993) to 14% (Kessler and Walters 1998; Kessler et al. 2003). Depression is highly co-morbid with other psychiatric disorders. More than 60% of adolescent patients with depression also meet diagnostic criteria for an anxiety disorder, and many go on to develop disorders of substance use. In children, depression also co-occurs with anxiety and disruptive behavior disorders.

When compared with the general population, people with physical illnesses are more likely to have mood disorders, specifically depression (Egede 2007; McDaniel and Blalock 2000; Patten 2001). Mood disorders are associated with higher health care costs, adverse health behaviors, significant functional impairment, lost work productivity, occupational disability, and increased health care utilization (Katon 2003).

Although much of the research on depression has focused on adults, growing numbers of children and adolescents living with general medical conditions face similar comorbidities. Evidence suggests that youngsters with physical illnesses are twice as likely to have depression as those in the community without physical illnesses. Those with depression are also at increased risk for worse medical outcomes and quality of life (McDaniel and Blalock 2000). Strong associations between depression and physical illness have been found among adolescents with obesity (Pine et al. 2001), headaches (Pine et al. 1996), and asthma (Mrazek et al. 1998). Adolescent depression has been associated with increased risk for medical hospitalizations and suicide (Kramer et al. 1998). Also, growing evidence indicates that depression may be a cause or consequence of some physical illnesses, such as cardiovascular disease, HIV/AIDS, cancer, epilepsy, and stroke (Evans and Charney 2003).

Mania is even less well studied than depression in children and adolescents. Controversy exists regarding the presence and recognition of pediatric mania. Evidence suggests that mania is not rare in this age group, although it can be difficult to recognize, and its diagnosis requires careful assessment (Biederman et al. 1998; Leibenluft et al. 2003; Wozniak et al. 1999). Current lifetime prevalence estimates for pediatric mania range from 0.9% to 1.2% (Gould et al. 1998; Kessler et al. 1994; Robins and Price 1991). Pediatric mania has been significantly associated with increased suicidal ideation and attempts (Gould et al. 1998).

Despite the recognition of increased comorbidity of mood disorders and their potential adverse impact, they remain underdiagnosed and undertreated in pediatric patients with physical illnesses. In this chapter, we review clinical features and considerations in depression among children with physical illness, challenges to diagnostic assessment, risks associated with comorbid depression, features of depression in specific populations, and approaches to treatment.

Eliminating Stress and Anxiety From Your Life

Eliminating Stress and Anxiety From Your Life

It seems like you hear it all the time from nearly every one you know I'm SO stressed out!? Pressures abound in this world today. Those pressures cause stress and anxiety, and often we are ill-equipped to deal with those stressors that trigger anxiety and other feelings that can make us sick. Literally, sick.

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